Healthcare Provider Details

I. General information

NPI: 1669010716
Provider Name (Legal Business Name): JACK DONOVAN SINKEL RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2019
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 VETERANS DR
SAINT CLOUD MN
56303-2015
US

IV. Provider business mailing address

4360 CLEARWATER RD APT 362
SAINT CLOUD MN
56301-6464
US

V. Phone/Fax

Practice location:
  • Phone: 320-252-1670
  • Fax:
Mailing address:
  • Phone: 763-244-9836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number4636
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: